Mobile Stroke Units Might Trim Time to Treatment
WEDNESDAY April 11, 2012 -- Clot-busting drugs can help stave off lasting disability after a stroke, but they must be given within a 4.5-hour window and many people arrive at the hospital too late to use them.
Now, German researchers report that they think they have found a solution to the problem: mobile stroke units. Equipped with what is needed to diagnose and treat a stroke, these ambulances are stocked with clot-busting tissue plasminogen activator (tPA) and the CT scanning technology needed to confirm whether an ischemic stroke has occurred, blood flow is blocked and it is safe to use tPA.
Unfortunately, while the mobile stroke units did speed the time to treatment, this did not lead to improvements in neurological outcomes or increase the number of people who received tPA. The findings are published in the April 11 online edition of The Lancet Neurology.
In the study conducted by Dr. Klaus Fassbender and his colleagues from the University of the Saarland in Homburg, 100 people with suspected stroke were either treated in the mobile stroke units or at the hospital. Use of mobile stroke units roughly halved the time from the initial emergency call to treatment decision, from 76 minutes to 35 minutes.
What's more, treatment in a mobile stroke unit also lowered the time from symptom onset to therapy decision to less than an hour for 57 percent of people. By contrast, just 4 percent who were treated in the hospital were evaluated in under an hour.
The time from calling emergency services to administering treatment was 38 minutes among people treated in the mobile unit versus 73 minutes among those who were treated at the hospital, the investigators found.
Commenting on the study, Dr. Larry Goldstein, director of the Duke Stroke Center in Durham, N.C., said that while an interesting concept, mobile stroke units may not be feasible in the United States due to cost. "There might be some circumstances where such a thing might be considered, but that would really have to be thought through very carefully."
Unless and until that occurs, the best way to make sure that people with suspected stroke get treatment promptly is to have 911 operators trained to recognize that a caller may be having a stroke and dispatch the appropriate unit to take them to the nearest stroke center where they can be evaluated and treated as quickly as possible, Goldstein said.
Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City, added that "the concept of a mobile stroke unit is a promising approach to more rapidly and effectively assess and treat patients with acute strokes in the field."
Some potential downsides include the cost of the set-up, Glatter pointed out. "We will need an adequately powered, larger multi-center trial to answer the question of whether largely urban-based mobile stroke units ultimately improve outcome of stroke patients in the 'time is brain' paradigm," he noted.
Glatter agreed that knowing the symptoms of a stroke is the most important way to make sure that care is delivered in timely fashion. Stroke symptoms may include facial drooping, difficulty speaking, sudden numbness, dizziness and confusion.
Is it a stroke? Learn the symptoms at the National Stroke Association.
Posted: April 2012